The home as an appropriate setting for women undertaking cervical ripening before the induction of labour.

Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow, UK.
Midwifery (Impact Factor: 1.12). 02/2011; 27(1):30-5. DOI: 10.1016/j.midw.2009.11.003
Source: PubMed

ABSTRACT to explore women's experiences of cervical ripening using isosorbide mononitrate (IMN) in the home as part of the main randomised controlled trial.
qualitative study with semi-structured interviews carried out at three weeks post partum. Interview transcripts were analysed to identify recurrent themes, focusing on why women became involved in the study, their views about both the self-medication and the home setting, and whether they would repeat the experience.
the home.
twenty women enrolled in the main randomised controlled trial.
the study is part of a double-blind randomised controlled trial with 350 patients investigating whether a nitric oxide donor (IMN) used in cervical ripening improves the process of induction of labour.
women liked the opportunity to remain at home during the cervical ripening process. Timing and setting were central issues; women hoped that it would hasten labour, while the home was seen as a setting offering freedom, security and reassurance, as opposed to the hospital, seen as constraining. Two women reported problems with IMN but the remainder reported that they would repeat the experience.
women were very positive about the opportunity to undertake cervical ripening at home. It is important to explore this setting further for appropriate interventions.

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    ABSTRACT: Objective To compare clinical outcomes from outpatient with inpatient cervical prostaglandin E2 ripening for low risk labour induction.DesignRandomised controlled trial.SettingTwo tertiary hospitals in Adelaide, Australia.PopulationWomen with uncomplicated term pregnancies, scheduled for induction of labour for reasons of post-dates or for social reasons.Methods Eight hundred and twenty-seven women were randomised at induction decision to an outpatient or inpatient group. All women had CTG monitoring before and after vaginal PgE2 administration. The inpatient women were admitted and the outpatient group was discharged home overnight with instructions to return if labour established or rupture of membranes occurred. Next morning, outpatient women were admitted for rupture of membranes or further ripening. After membrane rupture, both groups received routine care.Main outcome measuresOxytocin use, maternal and fetal outcomes, and whether planned outpatient management was achievable.ResultsThere were no significant differences in oxytocin use (2.5% difference, CI−4.3 to 9.4), caesarean sections (−0.59% difference, CI−6.3 to 5.1), epidural use (1.5% difference, CI−5.1 to 8.2), vaginal delivery within 24 hours (−8.2% difference, CI−17.6 to 1.3) or labour complications. More than half of the randomised women did not receive the intervention as they laboured spontaneously, or did not require ripening. The post-hoc analysis of women who received ripening also indicated no statistically significant differences in the patterns or results, with the exception of outpatient women having a longer mean length of active labour (mean difference 66 minutes, CI 4–128 minutes). Outpatient women who received ripening were diagnosed more frequently with non-reassuring CTG monitoring and hyperstimulation, with less than half of the women going home and remaining home overnight.Conclusions This study demonstrated no clinical advantage or disadvantage in prostaglandin E2 outpatient cervical ripening. Uterine stimulation following prostaglandins may preclude a woman from going home or remaining at home overnight and may not be the best agent for outpatient ripening.
    BJOG An International Journal of Obstetrics & Gynaecology 05/2014; · 3.76 Impact Factor
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    ABSTRACT: To investigate women's experience of induction of labor. Design. Mixed methods study. Setting English maternity units. Women who gave birth in a two week period in late 2009, excluding women aged less than 16 years and women whose baby had died. This study involved secondary analysis of data from questionnaires relating to care in childbirth. Women's experience of induction of labor was compared to that of women who labored spontaneously by analysis of responses to structured survey questions. Responses to open questions relating to induction were analysed qualitatively. Satisfaction with care, mode of delivery, experience of induction of labor. The response rate to the survey was 55.1% representing 5333 women, 20% of whom were induced. Nulliparous women, those with long term health problems, or specific pregnancy related problems were significantly more likely to be induced. Women who were induced were generally less satisfied with aspects of their care and significantly less likely to have a normal delivery. In the qualitative analysis the main themes that emerged concerned delay, staff shortages, neglect, pain and anxiety in relation to getting the induction started and once it was underway; and in relation to failed induction, the main themes were plans not being followed, wasted effort and pain, and feeling let down and disappointed. Women having an induction were generally less satisfied with their care, suggesting the need for a focused service for these women to address their additional needs. This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 07/2013; · 1.85 Impact Factor
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    ABSTRACT: Objective To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Methods Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Results Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of $319 per woman (95% CI -$104 to $742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of $433 (95% CI -$282 to $1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to $156 per woman. Conclusions Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However, the trend in cost savings favoured outpatient priming. What is known about the topic? Induction of labour is a common obstetric intervention. For women with low-risk, prolonged pregnancies who require cervical priming there has been increased interest in whether this period of waiting for the cervix to 'ripen' can be achieved at home. Outpatient priming has been reported to reduce hospital costs and improve maternal satisfaction. However, few studies have actually examined the cost of outpatient priming for induction of labour. What does this paper add? This is the first paper in Australia to both assess the full cost of outpatient cervical priming and to compare it with usual (inpatient) care. This is the first costing paper from a randomised controlled trial directly comparing inpatient and outpatient priming with prostaglandin E2. What are the implications for practitioners? For women with prolonged, low-risk pregnancies, a program of outpatient cervical priming can potentially reduce in-hospital costs and free up labour ward beds by avoiding an additional overnight hospitalisation.
    Australian health review: a publication of the Australian Hospital Association 09/2013; 37(4):467-73. · 0.70 Impact Factor

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